左心房应变判断运动负荷超声心动图舒张功能反应性的价值

The prognostic value of left atrial strain in diastolic function response to exercise stress echocardiography

目的:探讨左房应变对平板运动负荷超声心动图舒张功能负荷试验反应性的判断价值。方法:纳入2018年5月至2019年2月空军军医大学唐都医院64例进行平板运动负荷超声舒张功能评估的患者,以运动负荷前舒张早期二尖瓣血流速度/舒张早期二尖瓣环运动速度比值(E/e′)<14、运动后E/e′>14为舒张功能负荷试验反应阳性,运动后E/e′<14为反应阴性。比较两组间运动负荷试验一般资料、左室内径、左房容积指数、收缩及舒张功能,以及左房应变参数。选取组间差异有统计学意义( P<0.01)的负荷前超声指标绘制ROC曲线,判断其对舒张功能负荷试验反应的预测价值。 结果:E/e′及左房应变各指标组间差异有统计学意义,其中舒张功能负荷试验反应阴性组的运动负荷前E/e′低于阳性组(8.20±1.27对10.32±1.33, P<0.01),而各左房应变指标高于阳性组[储备功能(33.7±5.7) %对(26.5±5.5)%, P<0.01;通道功能(16.8±4.0)%对(11.8±3.4)%, P<0.01;泵功能(16.9±5.7) %对(14.7±5.5)%, P<0.05]。左房应变储备功能、通道功能及E/e′对舒张功能负荷试验反应性均具有判断价值,ROC曲线下面积分别为0.81( P<0.01)、0.62( P=0.04)、0.71( P<0.01)。 结论:静息状态左房应变能够判断舒张功能负荷试验反应性,有望在一定程度上替代运动负荷超声心动图进行舒张功能评估。

Objective To study the prognostic value of left atrial strain in diastolic function response by treadmill exercise stress echocardiography.Methods During May 2018 to February 2019,64 patients underwent treadmill exercise stress echocardiography for diastolic function evaluation in Tangdu Hospital,Air Force Medical University,were recruited.Patients were categorized into diastolic stress test negative group(pre-stress E/e′<14&post-stress E/e′<14)(DST-group),and diastolic stress test positive group(pre-stress E/e′<14&post-stress E/e′>14)(DST+group).Patients′characteristics of the stress test,left ventricular diameter,left atrial volume index,systolic and diastolic function,and left atrial strain parameters were compared between these two groups.ROC analyses were performed based on the echocardiographic parameters with significant group differences(P<0.01)to determine the predictive values for diastolic stress test response.Results The pre-stress E/e′and left atrial strain parameters were significantly differently between DST-and DST+group.The DST-showed significantly lower E/e′(8.20±1.27 vs 10.32±1.33,P<0.01),but higher left atrial strains than DST+group[reservoir function(33.7±5.7)%vs(26.5±5.5)%,P<0.01;conduit function(16.8±4.0)%vs(11.8±3.4)%,P<0.01;pump function(16.9±5.7)%vs(14.7±5.5)%,P<0.05].The left atrial reservoir function,conduit function and pre-stress E/e′could predict the diastolic stress test response,the areas under ROC curve were 0.81(P<0.01),0.62(P=0.04)and 0.71(P<0.01).Conclusions The left atrial strain parameters under resting condition could predict the diastolic stress test response.It may serve as an alternative method of exercise stress echocardiography for diastolic function evaluation.